Presentation
Patient with end-stage renal disease on hemodialysis for 15 years with generalized body weakness and poor oral intake. Presented with epigastric pain and nausea for a few days.
Patient Data
Thick wall of the gallbladder containing a moderate amount of biliary mud with tiny echogenic foci ? tiny stones. Mild intrahepatic biliary radicals dilatation is noted. CBD is mildly dilated.
Small size of both kidneys with numerous small cysts. A small left renal stone is noted.
Dilated common bile duct (13 mm) with mild intrahepatic biliary radicles dilatation.
Distended gallbladder containing few tiny low T2 signal foci as well as the distal part of CBD suggestive of tiny stones.
Renal parenchyma bilaterally is replaced by numerous small cysts, suggestive of dialysis-associated renal cystic disease.
Mild splenomegaly (15.5 cm).
Small paraumbilical hernia with linea alba defect 1.4 cm.
Case Discussion
Decreased body movement and poor oral intake are predisposing factors for the formation of biliary mud. It can lead to obstructive jaundice and the formation of biliary stones.
Long-term dialysis can lead to the development of numerous small cysts in both kidneys, called acquired cystic kidney disease. Differential diagnosis is autosomal dominant polycystic kidney disease, but cysts are smaller and there is no renal enlargement.